Differential Expression in Markers for Thrombin, Platelet Activation, and Inflammation in Cell Saver Versus Systemic Blood in Patients Undergoing On-Pump Coronary Artery Bypass Graft Surgery

Objective: Elimination of cardiotomy suction increases reliance on cell-saver blood-conservation techniques. Reinfusion of processed cell-saver blood (PCSB) even without using cardiotomy field suction may contribute to thrombin, cytokines, platelet activators, and hemolytic factors measured systemically.Design: This study was designed as a prospective, unblinded observational study of patients undergoing first-time, nonemergent on-pump coronary artery bypass graft surgery.Setting: A university medical center.Participants: Fourteen patients were enrolled after informed consent.Interventions: Arterial blood was sampled (1) before cardiopulmonary bypass, (2) immediately after bypass, and (3) 4 hours after bypass. PCSB, using the AutoLog (Medtronic, Inc, Minneapolis, MN), was sampled after bypass.Measurements and Main Results: Blood and PCSB levels of prothrombin fragments 1.2, β-thromboglobulin, interleukin-6, interleukin-8, polymorphonuclear leukocyte-elastase, neuron-specific enolase, and S-100β were assayed by using enzyme-linked immunosorbent assay. Paired comparisons were performed by using paired t tests. Compared with postbypass blood, processed cell-saver blood (prepatient infusion) had higher levels of polymorphonuclear leukocyte-elastase, interleukin-8, neuron-specific enolase, and S-100β (p ≤ 0.05).Conclusions: Reinfusion of PCSB directly and independently contributes to systemic elevations in interleukin-8, polymorphonuclear elastase, neuron-specific enolase, and S-100β, augmenting and perhaps accentuating the postoperative inflammatory response. Further evaluation and improvement in cell-salvaging technology and processing techniques are warranted.